NPIMap

Individual provider Active NPI

Sajid Latif, M.D.

  • Nephrology Physician
  • Port Orange, FL
National Provider Identifier
1265429823
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
ME0070777 Issued in FL
Practice address
4641 S Clyde Morris Blvd
Unit 201
Port Orange, FL 32129-6003
Phone
(386) 322-6340
Fax
(386) 322-6212
NPI assigned
Sep 29, 2005
Last updated
Feb 9, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X ME0070777 FL Primary

Addresses

Primary practice location

4641 S Clyde Morris Blvd
Unit 201
Port Orange, FL 32129-6003

Mailing address

4641 S Clyde Morris Blvd
Unit 201
Port Orange, FL 32129-6003
Phone (386) 322-6340

Other identifiers 8

IdentifierTypeStateIssuer
P936412OtherFLOPTIMUM
005982OtherFLORIDA HEALTH CARE PLAN
262829832OtherFLHUMANA
390006858OtherRAILROAD MEDICARE
253569600MedicaidFL
1916107OtherFLAETNA
42321OtherFLBCBS
N448386OtherFLHEALTHEASE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081007000267 FL Practitioner - NephrologyPractitioner - Internal Medicine 7315015104 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Renal Care Consultants PLGroup PAC ID 0941378731, 2 clinicians

Practice addresses (Care Compare)

4641 S Clyde Morris Blvd
Suite 201
Port Orange, FL 32129-6002
Phone (386) 322-6340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0070777FLMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Renal Care Consultants PL Nephrology CurrentSince Jul 1, 2008 Accepting new patients
Daytona Beach Vascular Access, LLC PastSince May 28, 2023 Accepting new patients
Volusia-Flagler Vascular Center LLC PastSince Feb 1, 2010 Accepting new patients

Locations

4641 Clyde Morris Blvd
Unit 201
Port Orange, FL 32129
Phone (386) 322-6340

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1265429823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 S CLYDE MORRIS BLVD",
            "address_2": "UNIT 201",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296003",
            "telephone_number": "386-322-6340",
            "fax_number": "386-322-6212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 S CLYDE MORRIS BLVD",
            "address_2": "UNIT 201",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296003",
            "telephone_number": "386-322-6340",
            "fax_number": "386-322-6212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATIF",
        "first_name": "SAJID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "FL",
            "license": "ME0070777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM",
            "identifier": "P936412",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA HEALTH CARE PLAN",
            "identifier": "005982",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "262829832",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "390006858",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253569600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1916107",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "42321",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHEASE",
            "identifier": "N448386",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.